Prevalence, Features, and Prognosis of Artery‐to‐Artery Embolic ST‐Segment–Elevation Myocardial Infarction: An Optical Coherence Tomography Study

BACKGROUND: The major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery‐to‐artery embolic myocardial infarction (AAEMI) was defined as ST‐segment–elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography. METHODS AND RESULTS: This study retrospectively enrolled 297 patients with ST‐segment–elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm(2) [interquartile range (IQR), 2.2–4.9] versus 1.0 mm(2) [IQR, 0.8–1.3] versus 1.0 mm(2) [IQR, 0.8–1.2] versus 1.1 mm(2) [IQR, 0.7–1.6], P<0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm(2) [IQR, 2.5–6.7] versus 1.5 mm(2) [IQR, 1.0–2.4], P<0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm(2) (IQR, 1.0–2.1), 40% of them had nonstent strategy, and the 3‐year major adverse cardiac event rate was 0%. CONCLUSIONS: AAEMI is a rare cause for ST‐segment–elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site.